Sample Process Recording - First Year MSW Student

Transcription

1 Sample Process Recording - First Year MSW Student Agency: Surgical Floor, City Hospital Client System: Harold Harper, age 68, retired widower Date: November 18, 20xx Presenting Issues: Cardiologist observed that patient appeared depressed when told he needed heart surgery and requested a psychosocial assessment. Purpose of Interview: First interview; referred by Mr. Harper s cardiologist for assessment Content Skills Used Gut Reaction Analysis Field Instructor s Comments When I approached Mr. Harper s room, I could hear the TV playing very loudly. I knocked on the door but he didn t hear me so I stepped inside and finally got his attention. S (Student): Mr. Harper, my name is Joe Jones. I m an intern from the Social Work Department here at the hospital. May I come in and talk with you for a few minutes? C (Client): What did you say your name is? I can t hear you? S: Would it be OK if I turn the TV off while we talk or Uh-oh. Mr. Harper may have problems hearing. I feel very awkward having to yell with people walking by. You re respecting Mr. Harper s ability to choose a time to talk 1

2 would you like me to come back at a different time? C: Go ahead and turn it off. There s nothing good on anyway. It s just a stupid waste of time. I turned off the TV and stood next to Mr. Harper s bed. His white hair was uncombed and he was wearing a hospital gown. His eyes looked down. S: Mr. Harper, my name is Joe Jones. I m an intern from the Social Work Department here at the hospital. I m here to see how you re doing. C: What the heck is an intern? S: I m in a graduate program studying to be a social worker. Because I m learning, I work closely under the supervision of one of the hospital s social workers. C: Well, you look about the same age as my grandson. S: Are you concerned that I might not be able to help you? I m relieved - his hearing seems OK. I feel a little defensive about being a student. What if he wants to see a regular social worker? I m not sure why I was so vague about the reason for my visit. He looked old and sad and I thought starting out by asking about his upcoming surgery might make him feel worse. I ve been learning in class about transference. Is that what s happening? My best guess is this is his real concern. I m inexperienced and I look with you. Good observations of Mr. Harper. You re picking up on non-verbal cues as to his mood and state of mind. Excellent hypothesis. Let s talk about this in supervision. What gut reaction did you have when he compared you to his grandson? 2

3 C: Well, I don t even know if I need your kind of help. I have good insurance and a place to live. S: I should have explained the kind of help I can offer. Social workers in the hospital can help with the things you mentioned. But being in a hospital can also be upsetting, especially when you re not prepared for being here. I m here right now to see if you d like to talk about how you re feeling and ask if there s anyway I can help. I understand you have heart surgery scheduled for the day after tomorrow. C: How do you know that? (Mr. Harper looked at me suspiciously at this point.) S: Your cardiologist asked a social worker to stop by and see you. She understands that people often have some worries before surgery. I know she explained what will happen during surgery. I m wondering how you re feeling Explaining my role I feel confident providing this information and pleased that I can widen his ideas about what social workers do. young. People often misunderstand what social workers do. This information is important for Mr. Harper to know, but it can be overwhelming so I m trying to stick to the most relevant things about my role. I want Mr. Harper to see me as someone he can trust so I tried to answer directly. A clear explanation of the purpose of your visit. Good work in normalizing the situation and in being clear that you and the doctor have different roles in helping him while he s in the hospital. 3

4 about everything. Your surgery is unexpected is that right? C: I ll get through it, just like I always get through things. S: How do you usually get through things? C: Grin and bear it, young man. I fought in Vietnam and that s how I got through that hell. S: Oh. Tell me what you do when you grin and bear something? C: I don t think about things too much. I just set my mind on what I need to do and do it. S: Did that help you in Vietnam? C: You bet it did. If I thought too much about what could happen in that place, I would have gone nuts. Open-ended question Clarifying Probing for more information I feel admiration for him. My grandfather was a Vietnam vet, too. I decided not to ask him right now about Vietnam, but to try to understand more about how he copes with stressful situations. I hope this was the right direction to go. Good follow-up question because it s the specifics of how he copes that are useful in understanding how he s managing his current situation. You re correct this is an important decision point in the interview. Based on the direction the interview took, assess the choice you made and we ll talk about this when we meet. 4

5 S: So you try not to think too much when you re in a tough place. C: Yup! My wife, God rest her soul, understood that s how I was and she didn t try to push me to talk about everything. She just stood by me and let me work things out myself. S: Perhaps it s hard not to have her standing by you right now. C: Well, she s not here and that s just the way it is. Where did I put the remote to that stupid TV? [Mr. Harper started pulling at the different cords on his bed and turned as far away from me as he could.] S: Would you like me to leave? I could come back at a better time. Mr. Harper didn t say anything but he kept his face turned away. S: Mr. Harper, I m sorry if something has upset you. Was it something in our Showing empathy I m feeling concerned for Mr. Harper - he seems alone. Wow. I felt awkward. He seemed to be dismissing me all of a sudden. I m worried that my talking with him has made Mr. Harper feel worse. I decide again to stick with understanding his coping strategies. I don t seem to be helping him. Maybe I shouldn t have made that comment about his wife. I don t know what to try next. I didn t know if this was a good idea or not. But telling him that I wanted Do you think he might be trying to send you a message of Do not push me? I agree; this intervention was effective. Sometimes students are afraid that is a client cries or 5

6 conversation? I d like to understand and help if I can. C: [He was quiet at first, then when he started to say something, his voice choked up.] The doctor thought she saw tears when she was here and that s probably why she asked you to talk to me. Women think crying is fine, but I m not a crier. I m a strong man and I take care of myself. S: I think you re very strong, Mr. Harper. You survived a terrible war and now you re preparing yourself for heart surgery in the way you think is best. C: If my wife were here, she d know what to do. S: Is there anyone else you d like to have near you as you Emphasizing client strengths Exploring his support system I saw tears in Mr. Harper s eyes. He looked away again quickly though. I felt anxious about what to say next, but I also felt very warmly toward Mr. Harper who was trying hard to be brave. I felt sad. He really misses his wife. to help seemed to work at least he turned his head toward me for an instant. shows any strong emotion, something went wrong in the interview. You didn t leave the room or try to distract Mr. Harper from his strong feelings. Instead you reacted with concern for how he was feeling. What did you learn from your interactions in this section of the interview? You seemed to sense that Mr. Harper needed to have confirmation of his view of himself as strong. 6

7 wait for your operation? C: I have a daughter, Delia, but she lives in Philadelphia and I don t want to bother her. She s got 3 kids and they keep her busy. S: Does your daughter know that you re scheduled to have heart surgery? C: No. I didn t know myself until yesterday after the doctor had all my test results. Delia s a kind person, just like her mother, but I don t want to worry her with my problems. S: What would you think about calling Delia and letting her know about your upcoming surgery. It would be up to her to decide if she could come to Baltimore, but I bet she d like to know how you are. C: I could do that, I guess. Just call her and let her know. She might be a little annoyed with me if I don t call her. She s always telling me that I Closed question Offering a suggestion Wow. His face lit up when he mentioned his daughter. Asking him if there was anyone else he d like to have with him helped him focus on coping with his present situation. I think making this suggestion was appropriate. I got the sense that he wanted to call his daughter and just seemed to need a little nudge. Good analysis of why you think your question was effective here. I agree. 7

8 shut down and don t let people in. That s her expression she says, Dad, stop shutting down. S: Your daughter sounds like she cares about you. C: I guess she does. (He sighed.) I know she does. Just thinking about Delia makes me feel a little better. I can call her tonight after dinner. S: That sounds like a good plan. I d like to stop by tomorrow and see how the phone call went and how you re doing. Would that be OK? C: Sure. Talking with you hasn t been as tough as I Arranging follow up Having met Mr. Harper, I could just picture someone who loves him trying to get him to open up a little. Wow. Maybe he was worried about talking Good work in helping Mr. Harper manage his anxious anticipation of his upcoming surgery. You stayed where the client was during this interview, building up trust, and he gradually became open to accepting your help. Through collaboration, you and Mr. Harper came up with a plan whereby he was willing to accept some support. This is a fine accomplishment given his usual coping style of grin and bear it. Although I think you re right in your Plan for your next meeting 8

9 thought. with me. I never thought of that. I just thought I was worried about how to talk with him. that just talking to his daughter may help Mr. Harper feel better, let s discuss how you could prepare for the possibility that he s unable to reach her or feels let down by her response. Student s Assessment: I felt great after this interview. We talk a lot at school and at the hospital about the importance of social support, but I could really see it in talking with Mr. Harper. I think I helped him feel better by imagining how he could use his daughter s support at this time. I also felt a real connection with Mr. Harper by the middle of the interview. I admired him and cared about him. I think my feelings helped me get through the difficult time when I thought I might be making things worse and wished I could leave. Plan for Next Meeting: I plan to stop by tomorrow as planned and see if he reached his daughter and how their conversation went. I hope she can come, but just telling her about his upcoming surgery may help him feel better. When I see him tomorrow, I ll also have a chance to assess his mood. Teaching/Learning Points for Field Instructors about this Process Recording: This interview is an example of very good performance by a student in a first-year field placement. He demonstrates skill in active listening, asking follow up questions to clarify his understanding of the client s situation, and showing empathy. He demonstrates respect and concern for the client. This student appears to be less self conscious than many foundation students and thus better able to focus attention on his client. Although the student could include more in the gut reactions column, he shows good self-awareness for a first-semester, first-year student. One of his strengths in this interview is his ability to stay with the client, even when he felt awkward and wished he could leave when the client was experiencing painful feelings. Although the student shows some awareness that what he did worked, the field instructor provides a conceptual framework for understanding how it worked in several of her comments. Understanding why, and the conditions under which, an intervention worked can help the student to apply their learning to other situations. In her comments the field instructor also encourages the student to build on his analytic skills by posing questions for him to consider and discuss with her in supervision. 9